Signing up for Medicare can feel daunting. Today, we’re covering the basics of what you need to know about Medicare – what it is, what’s covered, how to sign up, and more.
Some people get enrolled automatically, and others have to sign up. If, for example, you are 65 years old and not getting Social Security, you’ll likely have to sign up on your own.
There are also certain times of the year when you can sign up or change your coverage.
There are different parts and types of Medicare you should be aware of. But first, here are the basics:
Medicare is the federal health insurance program for:
- People who are 65 or older
- Younger people with certain disabilities
- People with end-stage renal failure (those requiring dialysis or a kidney transplant)
Different “parts” of Medicare cover certain services.
Medicare Part A covers inpatient hospital stays, nursing home care, hospice care, and some home health services.
Medicare Part B covers some doctors’ visits, outpatient services, some medical supplies, and preventive visits.
Medicare Part D covers the cost of prescription drugs, which includes vaccines.
Medicare Part C is what the Advantage plans are (People’s Health, Blue Advantage, Humana Gold): these can be less expensive up front but are very restrictive for patient’s choice.
There is Original Medicare, Medicare Advantage, and Medicare drug coverage (part D)
When you first enroll in Medicare, you can choose your coverage. There are 2 ways you can get your coverage – Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C.)
It is extremely important to understand if you have part A, part B or both. This will help you to avoid extremely large bills.
Some people may need to enroll in additional coverage, like prescription drug coverage or supplemental insurance (Medigap.) Remember, that Medicare only covers 80% of what the government believes is an allowable cost. That means there is a lot of the true cost of care that is uncovered. Medicare supplemental plans cover that ‘gap’ in coverage by the government.
Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (office-based or outpatient care Insurance.) If you want drug coverage as well, you can enroll in a separate Medicare drug plan (Part D).
You can use any doctor in the US that takes Medicare, and also add other insurance, like Medicaid, supplemental insurance like Medigap, or employee or union coverage to help pay your out-of-pocket costs. This is not true for the Advantage plans.
Medicare Advantage (also known as Part C) is a bundled plan that includes Part A, Part B, and Part D. Medicare Advantage plans typically have lower up front out-of-pocket costs than Original Medicare. In most cases, you’ll need to make sure any medical provider you see is in your plan’s network.
In addition, these plans dramatically restrict patient access to many types of care, services, procedures and other aspects of healthcare.
Most of these plans offer additional benefits that Original Medicare doesn’t cover – like vision, dental, hearing, and more. Read the fine print of such offerings very carefully. Often, the coverage would be quite inexpensive on its own.
Obviously, this is just a very basic and introductory discussion. Insurance is very complicated and nuanced. Don’t be alarmed if you aren’t sure what type of Medicare to select. You are not alone. Most people have no idea what the details mean or how they matter for the future.
To learn more about Medicare, sign up for our seminar today!
